Importance In several randomized clinical trials, endovascular thrombectomy led to better functional outcomes than conventional treatment at 90 days poststroke in patients with acute basilar artery occlusion. However, the long-term clinical outcomes of these patients have not been well delineated. Objective To evaluate 1-year clinical outcomes in patients with acute basilar artery occlusion following endovascular thrombectomy vs control. Design, Setting, and Participants This study is an extension of the ATTENTION trial, a multicenter, randomized clinical trial. Patients were included between February 2021 and January 2022, with 1-year follow-up through April 2023. This multicenter, population-based study was conducted at 36 comprehensive stroke sites. Patients with acute basilar artery occlusion within 12 hours of estimated symptom onset were included. Of the 342 patients randomized in the ATTENTION trial, 330 (96.5%) had 1-year follow-up information available. Exposures Endovascular thrombectomy (thrombectomy group) vs best medical treatment (control group). Main Outcomes and Measures The primary outcome was defined as a score of 0 to 3 on the modified Rankin Scale (mRS) at 1 year. Secondary outcomes were functional independence (mRS score 0-2), excellent outcome (mRS score 0-1), level of disability (distribution of all 7 mRS scores), mortality, and health-related quality of life at 1 year. Results Among 330 patients who had 1-year follow-up data, 227 (68.8%) were male, and the mean (SD) age was 67.0 (10.7) years. An mRS score 0 to 3 at 1 year was achieved by 99 of 222 patients (44.6%) in the thrombectomy group and 21 of 108 (19.4%) in the control group (adjusted rate ratio, 2.23; 95% CI, 1.51-3.29). Mortality at 1 year compared with 90 days was more frequent in both the thrombectomy group (101 of 222 [45.5%] vs 83 of 226 [36.7%]) and the control group (69 of 108 [63.9%] vs 63 of 114 [55.3%]). Excellent outcome (mRS score 0-1) at 1 year compared with 90 days increased in the thrombectomy group (62 of 222 [27.9%] vs 45 of 226 [19.9%]) but not in the control group (9 of 108 [8.3%] vs 9 of 114 [7.9%]) resulting in a magnified treatment benefit. Conclusions and Relevance Among patients with basilar artery occlusion within 12 hours of onset, the benefits of endovascular thrombectomy at 1 year compared with 90 days were sustained for favorable (mRS score 0-3) outcome and enhanced for excellent (mRS score 0-1) outcome.

中文翻译：

---

急性基底动脉闭塞的血管内与药物治疗：一项随机临床试验的二次分析。


重要性 在几项随机临床试验中，血管内血栓切除术在急性基底动脉闭塞患者中风后 90 天的功能结局优于常规治疗。然而，这些患者的长期临床结局尚未得到很好的描述。目的 评价血管内血栓切除术后急性基底动脉闭塞患者与对照组的 1 年临床结局。设计、设置和参与者 本研究是 ATTENTION 试验的延伸，这是一项多中心、随机临床试验。患者于 2021 年 2 月至 2022 年 1 月期间纳入，随访 1 年至 2023 年 4 月。这项基于人群的多中心研究在 36 个综合卒中地点进行。纳入估计症状发作后 12 小时内急性基底动脉闭塞的患者。在 ATTENTION 试验中随机分配的 342 名患者中，330 名 （96.5%） 有 1 年随访信息可用。暴露 血管内血栓切除术（血栓切除术组）与最佳药物治疗（对照组）。主要结局和措施 主要结局定义为 1 年时改良 Rankin 量表 （mRS） 评分为 0 至 3。次要结局是功能独立性 （mRS 评分 0-2 ）、优秀结局 （mRS 评分 0-1 ）、残疾程度 （所有 7 个 mRS 评分的分布）、死亡率和 1 年时与健康相关的生活质量。结果 在有 1 年随访数据的 330 例患者中，男性 227 例 （68.8%） ，平均 （SD） 年龄为 67.0 （10.7） 岁。血栓切除术组 222 例患者中有 99 例 （44.6%） 在 1 年时达到 mRS 评分 0 至 3，对照组 108 例患者中有 21 例 （19.4%） 达到 0 至 3 分 （调整后比率，2.23;95% CI，1.51-3.29）。 血栓切除术组 （222 例中的 101 例 [45.5%] 对 226 例中的 83 例 [36.7%]）和对照组 （108 例中的 69 例 [63.9%] 对 114 例中的 63 例 [55.3%]）的 1 年死亡率更高。与 90 天相比，血栓切除术组 1 年时结局极佳 （mRS 评分 0-1） 增加 （222 例中有 62 例 [27.9%] vs 226 例中有 45 例 [19.9%]），但对照组没有 （108 例中有 9 例 [8.3%] vs 114 例中有 9 例 [7.9%]），导致治疗获益放大。结论和相关性 在发病后 12 小时内发生基底动脉闭塞的患者中，与 90 天相比，血管内血栓切除术在 1 年时的益处在良好的 （mRS 评分 0-3） 结局中持续存在，对于极好的 （mRS 评分 0-1） 结局增强。